Perianal Streptococcal Dermatitis

Introduction/Etiology/Epidemiology

■ Perianal streptococcal dermatitis is a distinctive superficial cellulitis caused by group A beta-

hemolytic streptococcus (GABHS). (Rarely, Staphylococcus aureus may be implicated.)

■ There is a male predominance and the condition has a peak incidence of age of 3 to 4 years.

■ Other family members may be similarly affected (especially if there is a history of co-bathing)
or may have streptococcal pharyngitis.

Signs and Symptoms

■ The typical presentation is that of intense perianal erythema (Figure 27.1), often with
associated pruritus or burning.

■ Maceration, exudate, fissuring, or desquamation may also be present.

■ The border between affected and unaffected skin is usually distinct.

■ Balanoposthitis or vulvovaginitis may also be present.

■ Parents may report that the child has pain with defecation, stool-holding, blood-tinged stools,
or increased irritability.

■ Fever is rare.
How to Make the Diagnosis

■ The diagnosis is suspected clinically and confirmed with bacterial skin culture, which usually
reveals GABHS.

■ A specific request to the laboratory is usually necessary because routine processing of perianal
swabs may involve inhibitors to the growth of GABHS.

■ S aureus is occasionally isolated.

Treatment

■ Oral penicillin or amoxicillin (erythromycin may be used if penicillin allergy) for 10 days,
combined with topical mupirocin.

■ Anti-staphylococcal antibiotic may be necessary if caused by S aureus.

Treating Associated Conditions

■ Vulvovaginitis or balanoposthitis, if present, usually responds to the therapy.

■ Guttate psoriasis may be associated with the condition and is treated with therapies typical for
psoriasis. (See Papulosquamous Diseases beginning on page 241.)

Prognosis

■ The prognosis is excellent, usually with complete healing following therapy.

■ More than one course of treatment is occasionally required.

When to Worry or Refer

■ Consider referral to a dermatologist when the diagnosis is in doubt, or when disease is severe
or extensive or does not respond to standard treatment.

■ If the history or examination findings point to abuse, appropriate evaluations and referral are
indicated.

Resources for Families

■ MedlinePlus: Medical encyclopedia for patients and families (in English and Spanish)
sponsored by the National Library of Medicine and the National Institutes of Health (search for
Perianal streptococcal cellulitis).

http://www.nlm.nih.gov/medlineplus/encyclopedia.html